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5 Things You Should Know About Reimbursement Claims in Mediclaim

Team AckoJun 19, 2023

Health issues, can be traumatic not just for the patient, but also for the family. In such a situation, the financial support offered by a Mediclaim policy is valuable. Policyholders want the claim process to be as effortless as possible to ensure that they receive financial support at the earliest.

Insurers aim to keep their claim settlement process quick and easy; however, there are certain processes that need to be followed. Thus, one must be honest, transparent and patient while applying for a claim on a Mediclaim policy. Read ahead to educate yourself about 5 must-know aspects of reimbursement claims in case of a Mediclaim policy.

5 Things You Should Know About Reimbursement Claims in Mediclaim

Contents

Reimbursement Claims in Mediclaim
Choose a Credible Insurer

Reimbursement Claims in Mediclaim

1 – Understanding Reimbursement Claims

Reimbursement, as the dictionary mentions, is a compensation paid for money already spent. With respect to a Mediclaim policy, reimbursement claims mean you pay the hospital bills first and get them compensated from the insurance company at a later stage.

2 – Initiative is Yours

Unlike the cashless reimbursement process where the insurance company settles the bill directly with the hospital, in a reimbursement claim, you have to make efforts to get your claim money from an insurance company. You have to take the initiative in case of a reimbursement claim for a Mediclaim policy by arranging documents, making the application, following up, etc.

3 – Arranging Necessary Documentation

Meticulous arrangement of hospital bills and other supporting documents is a key aspect in the reimbursement claim process of a Mediclaim policy. You might have to deal with a Third Party Administrator (TPA) in case of submitting documents. This step varies as per the insurance company’s claim settlement policy. You must keep photocopies of documents as you might be asked to submit the original ones.

4 – Intense Scrutiny

Every reimbursement claim application is scrutinized thoroughly by the TPA or the insurance company. This step is important for them as it is not a cashless claim and they are not associated with the network hospital directly. Hence, there is that extra check that needs to be performed to ensure the authenticity of the claim raised.

5 – Time Consuming Process

A reimbursement claim takes more time than a cashless claim because of the verification process mentioned above. Thus, one needs to be patient and cooperate with the TPA/ insurance company with regards to the precise documentation or any other query that they might have.

Choose a Credible Insurer

You must be judicious in choosing a credible insurer. After all, a smooth claim settlement process is what a policyholder desires while paying the insurance premium. If you have had a bad claim settlement experience with a particular insurance company, you can switch your Mediclaim insurer while renewing the policy. Have a look at the company’s Claim Settlement Ratio and online reviews to understand if they can be relied upon or not. If it is a new company, you can research about the investors and get more information on their website before purchasing the policy.

It is also suggested to compare policies based on price and coverage before purchasing. A Mediclaim premium calculator can come in handy in such a scenario. Online insurers and web aggregators have a Mediclaim premium calculator on their website that helps in understanding the approximate premium charged for the coverage desired.

It is like a simple calculator where you feed-in data and it displays the premium charged. You can try different combinations of the coverage desired to find out the premium charged for it and then make an informed decision. Nowadays, the calculator is a part of the online purchase journey itself; making the process more efficient.

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Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.

**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.